Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2021
Historical ArticleDoron medicum-the gift of medicine: How a rare 17th century medical translation positively impacted the community and predicted current analgesic techniques.
In 1683, a self-proclaimed apothecary physician and London professor of physick by the name of Guilelmus (William) Salmon authored a pharmacopoeia titled Doron medicum, the 'gift of medicine' (Greek/Latin translation). This text formulates an English supplement to the Latin Materia medica (16th century), discussing internal and external compound medicines of the late 17th century. This pharmacopoeia enabled those incapable of reading Latin to provide medical care to a challenging post-plague community. ⋯ A selection of opiate-based analgesic therapies, early critical care strategies and animal preparations are revisited. A small chronicle of William Salmon's life and professional achievements will be reviewed. Debate surrounding the opening of the first London Dispensary will be discussed in relation to William Salmon's contribution, echoing ongoing contemporary challenges in healthcare over 300 years later.
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Anaesth Intensive Care · Sep 2021
ReviewHistory of non-physician anaesthesia providers in Papua New Guinea: from heil tultuls to Anaesthetic Scientific Officers.
The most recent estimates, published in 2016, have indicated that around 70% of anaesthesia providers in Papua New Guinea are non-physician anaesthetic providers and that they administer over 90% of anaesthetics, with a significant number unsupervised by a physician anaesthetist. Papua New Guinea has a physician anaesthetist ratio estimated to be 0.25 per 100,000 population, while Australia and New Zealand have a ratio of 19 physician anaesthetists per 100,000, which is 75 times that of Papua New Guinea. To reach a ratio of seven per 100,000, recommended as the minimum acceptable by the Lancet Commission in 2016, there will need to be over 35 practitioners trained per annum until 2030, at a time when the average annual numbers of recent years are less than three physicians and less than five non-physician anaesthetic providers. We review the development of anaesthesia administered by non-physician indigenous staff and the stages of development from heil tultuls, dokta bois, liklik doktas, native medical assistants, aid post orderlies, and Anaesthetic Technical Officers up to the current Anaesthetic Scientific Officers having attained the Diploma in Anaesthetic Science from the University of Papua New Guinea.
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Anaesth Intensive Care · Sep 2021
Randomized Controlled TrialEffectiveness of enteral ivabradine for heart rate control in septic shock: A randomised controlled trial.
Persistent tachycardia in patients with septic shock predicts poor outcome. This study sought to investigate the effect of the cardiac pacemaker current inhibitor ivabradine on heart rate and cardio-circulatory function in patients with septic shock. After informed consent, 60 patients with septic shock and persistent tachycardia (heart rate >95 /minute) were prospectively randomly assigned to receive either standard therapy for septic shock (group S) or standard therapy along with enteral ivabradine (group I) for the initial 96 hours after enrolment. ⋯ Stroke volume index and ejection fraction were higher in group I while cardiac index and oxygen delivery parameters were maintained similar to group S. There was no difference in 30-day mortality or in the incidence of serious adverse events. Enteral ivabradine is effective in reducing heart rate, and improving haemodynamic parameters and cardiac function in patients with septic shock and persistent tachycardia, without increasing the incidence of adverse events.
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Anaesth Intensive Care · Sep 2021
Randomized Controlled TrialVentilatory performance of AMBU® AuraGain™ and LMA® Supreme™ in laparoscopic surgery: A randomised controlled trial.
The Ambu® AuraGain™ (Ambu A/S, Ballerup, Denmark) is a newer phthalate-free, single-use supraglottic device with the advantage of a facility for tracheal intubation if necessary intraoperatively. We compared the oropharyngeal leak pressures and other performance variables between the AMBU AuraGain and the LMA® Supreme™ (Teleflex Medical, Athlone, Co. Westmeath, Ireland) in patients undergoing laparoscopic cholecystectomy and preperitoneoscopic inguinal herniorrhaphy with carbon dioxide insufflation under controlled ventilation. ⋯ No cases of regurgitation and aspiration occurred, and minor postoperative complications were similar. The AuraGain exhibited higher oropharyngeal leak pressures than the LMA Supreme, but was slightly more difficult to insert. The higher oropharyngeal leak pressures suggest that ventilation might be less affected by high peak inspiratory pressures when using the AuraGain than the LMA Supreme.
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Anaesth Intensive Care · Sep 2021
ReviewPerioperative implications of newer generation drug-eluting coronary stents: A narrative review.
Newer generation drug-eluting stents are the most commonly inserted stent in the setting of percutaneous coronary intervention. This narrative review focuses on the evidence underpinning the perioperative management of patients with newer generation drug-eluting stents undergoing non-cardiac surgery. Six studies reported the incidence of major adverse cardiovascular events according to the time interval from percutaneous coronary intervention to non-cardiac surgery, and the comparative risks of newer and first generation drug-eluting stents. ⋯ However, the possibility of increased risk cannot be excluded as most studies were inadequately powered. The thrombotic risk is substantially reduced in patients with fourth (polymer free) generation drug-eluting stents, and urgent non-cardiac surgery can be considered one month after percutaneous coronary intervention. Larger multicentre studies are needed to define the optimal window for non-cardiac surgery after percutaneous coronary intervention and provide definitive perioperative strategies for patients presenting for non-cardiac surgery after the implantation of newer generation drug-eluting stents.